If I am interested in treatment at BALANCE, what is my first step?
Your first step is simply to call us at 212-645-6903. We are able to immediately schedule an intake assessment for you, or should you have further questions we will direct you accordingly
The purpose of this intake appointment is to get to know you, and to understand your history, current needs and treatment goals. This appointment will be with our intake coordinator and a nutritionist. This process enables us to make the appropriate recommendations for your treatment.
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I have tried many different eating disorder treatment programs, how are BALANCE’s programs different?
BALANCE is a small, intimate tranquil treatment center in the heart of New York City. We accept only up to 8 clients in one group at a time. BALANCE is the only program in NYC that offers such a small group setting. This allows us to provide the most personalized attention to each client and the coordination of their care. Treatment at BALANCE is highly individualized and "real world".
· A unique "real world" nutrition program
· All meals are served in an aesthetically pleasing fashion in a soothing, modern dining room
· Meals are ordered in from any one of a multitude of fabulous restaurants in our area
· Clients discuss their meal plans at least weekly with their program nutritionist and are active participants in creating their meal plans
· Clients' food preferences and fears are considered
· We have a very dedicated and experienced treatment team
· A low client-to-clinician ratio
· A small treatment community that fosters deep interpersonal connection
· A private, serene and soothing treatment environment
How long does treatment take?
The eating disorder treatment process is different for each client based on her/his specific needs and is customized accordingly. Depending upon the level of care a client's length of stay will differ. Our clients are enrolled in the Day Program for a minimum of 4 weeks with many extending for 6 to 8 weeks. Clients in the Weeknight Program are with us for a minimum of 6 weeks with many extending for 12 to 18 weeks.
We have minimum time requirements for our programs as we believe, and research has shown, that these lengths of stay offer the greatest benefit for clients, enabling a stronger foundation of recovery which is crucial in relapse prevention.
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What does a typical day in a BALANCE program look like?
BALANCE's Day Program runs five days per week from 8 a.m to 2:15p.m., Monday through Friday. We begin each day with a check in and pre-meal processing prior to breakfast. We move to the dining room for breakfast which is a communal dining experience. A clinician is present during all meals. After breakfast we transition from our dining room into our group therapy room for post-meal processing. This enables our clients to process the physical and emotional feelings that inevitably come up in each eating experience. The focus of post-meal processing is to highlight client successes, as well as looking at events that were challenging. As a group, we brainstorm alternative coping measures and solutions for the future, supporting each client in their own journey towards recovery. This structure is followed for the lunch as well, giving clients the opportunity to process their emotional and physical experiences around meals several times per day.
Clients participate in three group sessions per day. Group topics vary based on the weekly schedule with more structured behavioral formats as with our Cognitive Behavioral Therapy and Dialectical Behavior Therapy and more open, processing groups such as body image, multi-family group, and weekend process. Clients also participate in expressive therapy groups including art, yoga and drama therapy, giving individuals the opportunity to connect further to emotions and express these experiences in an alternative form. Clients will also have the opportunity to engage in real-life experiential outings including restaurant dining. On Friday afternoon, we allocate time for a planning and goal setting session during which the clinician and group members work together to plan the incorporation of skills learned in program and to anticipate challenges that may occur after program hours and over the weekend. In addition to the group schedule, each client is given a customized schedule outlining their individual session times for psychotherapy and nutrition counseling.
BALANCE’s Weeknight Program runs from 6 p.m. to 9 p.m., Mondays, Wednesdays and Thursdays. We begin each night with a check in, followed by a skills building group. We move to the dining room for dinner, which is a communal dining experience. Both our therapist and nutritionist are present at meals. After dinner we transition from our dining room into our group therapy room for post-meal processing. This enables our clients to process the physical and emotional feelings that inevitably come up in each eating experience. We then move into a group therapy session. The focus of the group sessions is to highlight client successes, as well as looking at events that were challenging. As a group, we brainstorm alternative coping measures and solutions for the future, supporting each client in their own journey towards recovery.
Group topics vary each night according to the schedule, with some more structured behavioral formats as with our Cognitive Behavioral Therapy and then more open, processing groups like interpersonal issues, family systems, body image and process. On Thursday evening, we allocate time for a planning and goal setting session during which the therapist and group members work together to plan the incorporation of skills learned in program and to anticipate challenges that may occur after program hours and over the weekend.
On any one of the three evenings before the program begins at 6pm, clients have their individual nutrition counseling session with our program nutritionist. As needed clients may also have an individual check-in session with our group therapist.
In all of our programs, it is required that clients maintain individual psychotherapy sessions with their core (outside) therapist. This includes medical and psychiatric support as needed. It is the client's responsibility to schedule these appointments directly with their providers.
What kind of alternative and experiential therapies do you offer in your programming for eating disorders?
Yoga therapy, art therapy and drama therapy are the three primary experiential therapies offered at BALANCE. Individuals have different ways of expressing emotion other than through verbal communication. Our goal is to provide an environment that allows our clients to tap into their internal emotional landscape even when they don't have the words. Through these therapies clients are able to access thoughts, beliefs, and feelings that may not have been as accessible through conventional talk therapy. This allows for a fuller understanding of self and individual behaviors.
What if I am Kosher, vegetarian, or vegan?
At BALANCE, our goal is to help clients develop a more neutral relationship with food. This means liberation of food, a lessening of food rigidity and food rules. To this end, we work closely with each client to determine their food preferences, likes and dislikes and attempt to reasonably accommodate those preferences. Within the safety of a supportive environment, we then encourage our clients to gently increase their food variety and scope. Thus while at BALANCE, our clients will be exposed to a number of different foods and cuisines. This is part of our "real world" focus. Within this framework, we can provide vegetarian meals. Kosher meals are also accommodated. We do work with vegan clients.
How do you establish how much each individual should eat?
At BALANCE, highly customized meal plans are established in collaboration with the client in an individual session with our program nutritionist. Each client that comes into program has her own unique calorie and nutrient requirements and health goals. Thus, needs are individualized accordingly. Our Weeknight Program meets three evenings per week, leaving a number of meals to be eaten independently outside of program by the client. Thus our goal is to establish a "real world" approach to food, portions and meals that make sense for the client and can be replicated successfully outside of program. Our goal is to provide enough structure to support clients towards their recovery and health goals.
While providing this structure we also introduce the concepts of mindfulness and intuitive eating that can be utilized as our clients become more independent with food and further in touch with hunger, fullness and satiety. When our bodies are able to interpret and respond naturally to hunger, fullness, and satiety weight balance and recovery become more sustainable.
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During program meals, do I have to finish everything on my plate?
We provide a grace period for the first 2 meals at BALANCE as a new client becomes acquainted with our program and meal style. After that period we do require 100% of meals to be completed. We do this because at this stage in recovery we find that it is the eating disorder that will often dictate consumption, not hunger and fullness, which are difficult to decipher. At each meal, following the plating example of our program nutritionist, clients self-plate their dinner portions themselves, and can be confident that they are eating a moderate portion that will not leave them at risk of over eating or under eating.
Eating disorders disturb the natural feedback mechanisms of hunger, fullness and satiety in many of our clients. Relearning how to "hear" these cues comes with eating consistently throughout the day, all meals and snacks. As clients move towards more intuitive eating, they will learn the joy and relief that comes with trusting their body to signal hunger and fullness, and to follow those cues. In doing so clients develop greater trust in their body, a more neutral relationship with food, and can slowly but surely let go of the belief that the body needs to be controlled.
Do you use an exchange system for menu planning in your programs?
At BALANCE our goal is to help our clients develop a more neutral relationship with food. This means reducing food rigidity and food rules which are inherent with an eating disorder. Initially however, as our clients are often not able to rely on their internal hunger and fullness cues to eat in a balanced nourishing way, we will provide support and education around a modified exchange system. Thus with this framework the clients can feel safe while at the same time practicing mindful and intuitive eating with each meal here in program. The goal is for our clients to use this structure only while they become more independent with food and learn how to interpret and respond to their internal cues naturally.
What is the average age of clients at BALANCE?
We treat adults (18 and older) in our main programs at BALANCE. We also offer an Adolescent Program for clients ages 12-17 years. Often there is a wide range of life stages and experiences among our group members. We have found that the diversity of our population, when discussed openly, enhances the treatment, providing rich opportunities for gaining insight into oneself and others. Our clients find meaningful commonalities that encourage feelings of connection and mutual understanding yet also benefit from exposure to the range of life experience of each unique participant.
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Do you accept low weight clients in your Weeknight Program?
Clients are evaluated on an individual basis. Each client goes through a thorough intake assessment and evaluation (medical, psychological and nutritional) before starting at BALANCE. In addition to meeting our program criteria, we require that a client is medically stable, and motivated towards recovery. We require all of our clients to be followed by their medical doctor while in program, and a thorough medical work-up is required as part of admission.
What percentage of your clients have Anorexia, Bulimia, and Binge Eating disorder?
We know that there can be up to a 50% overlap between anorexia and bulimia symptoms in any one client, and often clients report binge episodes as a part of their symptoms. What this means is that eating disorder labels do not fully capture the full presentation of a client's experience with symptoms. To this end we find that our clients, when they share their experience in group find they have more in common with other clients, no matter their diagnoses, than differences. We therefore offer a mixed group across the spectrum of eating disorder symptoms at BALANCE.
Should I be concerned that being in treatment with other people suffering with eating disorders might actually make me worse?
This is a common concern expressed by a number of our clients, especially if they have not been in a group setting before. What we find however is that the vast majority of our clients express enormous relief in group when they realize that they are not alone with their eating disorder and that fellow group members "get it", and get them, without judgement. The benefits of this connection within a group are that a client can feel supported and safe enough to be able to do the deeper work necessary to help them towards recovery. Hence the group experience enhances the recovery process.
In the case where a client may feel "triggered" by what they hear or observe in group, this actually provides an opportunity to further explore those feelings and reactions. It gives the treatment team more information about what goes on for you and helps us learn more about your emotional landscape. Real life also contains numerous triggers. In program the focus is on learning what those specific triggers are for each client, and even more importantly, how our client is able to navigate those triggers to remain safe and steady in their recovery process. This is where skills building and tolerance acquisition are essential.
Does my family get involved in my treatment?
At BALANCE we invite family members and significant others to join us in the treatment setting.
In our Day Program we offer a family group with breakfast every Tuesday morning. In the Weeknight Program we offer a biweekly multi-family group on Saturday mornings.
Although an eating disorder is individual, it does have ramifications on those around us, and likewise the people around us can influence our recovery process. To this end at BALANCE we feel it is important to offer support and provide education to those significant others around you so that they can have a deeper understanding of the illness, the recovery process and learn more about how they can be supportive and helpful.
Can I work while I'm in treatment?
As our Day Program is 30 hours per week, most clients find it beneficial to take a medical leave so they can put all of their focus on treatment and recovery. Once clients are ready for step down, our Weeknight Program is designed to allow clients to reintegrate work or school into their lives while also tending to their recovery.
Many of our clients are successful with this balance, however, it is still an exhausting endeavor to juggle both. For this reason we recommend that our clients try to minimize demands on themselves while in treatment to ensure they can get the most out of the program and can build a solid foundation for recovery.
Can I participate in just a few days of treatment each week?
Each level of care has its own time requirement. Our Day Program runs five days per week, and for continuity usually all five days per week are required. If a client has already been in outpatient treatment, and is highly motivated, we are able to offer a partial Day Program schedule. This is assessed on a case-by-case basis.
As a step down from the Day Program, the Weeknight Program runs three nights per week. In order to get the most out of the program, we require that clients participate in all three evenings.
Consistency and stability are essential in the early stages of recovery. Also as the program is a group program, the group dynamic is best protected and optimized in this manner.
What happens once I complete a program at BALANCE?
In our Day Program, at the end of the first four week commitment, clients are able to, and usually do, extend treatment. This is done in close communication with their treatment teams - both their core outside treatment team and the BALANCE team. After completion of the Day Program, clients then step down to our Partial Day or Weeknight Program.
At the end of the first six week commitment of our Weeknight Program, clients are able to, and usually do, extend treatment. This is done in close communication with their treatment teams - both their core outside treatment team and the BALANCE team. Often our clients report they are ready for more autonomy after 10 - 12 weeks.
As our clients are monitored closely right from the beginning of program, we are able to determine at specific milestones how they are progressing with respect to their treatment goals, and plan discharge accordingly. All discharge planning is done in collaboration with the client's core outside treatment team. Together we develop a discharge plan that often means a step down to outpatient individual nutrition and therapy sessions.